The first video that you'll see in your class is going to be called the science of resuscitation video, what I want to do is touch on the key points of the video that you'll need to focus on. While you're watching this during your class, we're going to go over the cardiac rhythms. We'll also go over waveform capnography. And we'll talk about that in just a moment. The CPR cycle, and then we'll talk about our defibrillation. We're going to call it the one shock protocol, and we'll explain that later.

And then we'll talk a little bit more about rapid response teams and what their jobs and responsibilities are. But let's talk about the rhythms that we're going to discuss. The first rhythm that we'll talk about is going to be ventricular fibrillation. The second one will be pulseless v tack, and then the third is going to be a sisterly just flatline where there's no electrical or mechanical activity going on. And then lastly, pa or pa Less electrical activity that's identified as a rhythm that looks like it's perfusing on a cardiac monitor. But when you feel the patient's pulse during a pulse check and cardiac arrest, they do not have a pulse.

So in essence, the the cardiac monitors lying to you, so we always have to double check that. So, we do have two shockable rhythms out of those that I just discussed. The shockable rhythms are going to be V fib, and pulseless v tack. Now the two things that those two rhythms have in common is they both have a letter V in them. If your rhythm does not have a V in it, you cannot shock it. So that's just a little tip for me to you.

It has a V in it, you can shock it, no v can't shock it. One of the biggest things that I focus on during the courses that I teach is waveform capnography. What is it? How do we get it and what do we use it for? So waveform capnography is the measuring of carbon dioxide that comes out of a patient. So you and I, we're real.

We're alive. We're happy. We're healthy. We take a breath in oxygen goes to our lungs, gets to the viola it does what it needs to do. And then that acid that carbon dioxide starts to build up in our brainstem says, Hey, you know what? I don't like that so much.

I want to get rid of it. So it tells us to exhale. So that is our carbon dioxide that's coming out. Now the normal levels of carbon dioxide for people that are alive and healthy is going to be 35 to 45 millimeters of mercury. So that's just like pressure from a blood pressure cuff. So remember your normal range for in tidal co2 or wave from Chem nog, Rafi is going to be 35 to 45 millimeters of mercury.

So how do we get it? hopefully at some point during the cardiac arrest, your patient becomes intubated. Once that et tube is placed into the patient and clinically verified that it is in the trachea. They're going to use a device called an inline co2 detector that gets placed on top of the endotracheal tube and the bag mask device gets placed on top of that, and what we'll see on the cardiac monitor There is a green line. So whenever we oxygenate our patient, we are putting oxygen into their lungs, the green line is going to drop to zero, because it's not collecting or it's not detecting any carbon dioxide. But when we let up off of that bag, that's when it's collecting or detecting the carbon dioxide and you'll see an upward inflection of the waveform capnography.

So whenever we squeeze the bag, it drops to zero. And whenever we let up off the bag, the green line will go up and it will measure how much carbon dioxide is coming out of somebody. So keep that in mind is going to be very important. Now we are going to use carbon dioxide or away from capnography in tidal co2 for three different things today. The first thing that it will do for us is it will tell tell us that the tube has been placed into the trachea. Keeping in mind if it hasn't been placed in the trachea, if they mistakenly placed it in the esophagus, you're not going to get any reading.

So it does verify 82 placement. Now, the second thing we use it for is we can use it as physiologic monitor to, to tell us how well we're doing CPR. So somebody who's dead, they're in cardiac arrest, they're not breathing, and the heart's not beating. So it's up to us to fix that. So we definitely want to provide oxygenation and ventilation. But that's not good enough, we actually have to move that oxygenated blood through the lungs and create the carbon dioxide for them.

So this is what we're going to do. Just the mere presence of waveform capnography tells us that the tube has been placed into the trachea. And then now we're going to use it to measure the quality of CPR. Once we're doing chest compressions on our patient, we should see the waveform capnography You know, every time we squeeze that bag, upward and downward inflections, if the waveform capnography is consistently less than 10 millimeters of mercury, that suggests to us that we are not doing high quality CPR, or our goal is to push harder, faster, maybe somebody fresh on the chest, and then we want that way from capnography to be as close to 20 20 millimeters of mercury is possible. So here's a simple trick to remember during cardiac arrest once they've been intubated. If the way from capnography is consistently less than 10 millimeters of mercury, bad CPR 10 to 20 millimeters of mercury, good CPR.

Excellent. Now let's talk about the CPR cycle, everything is going to revolve around a two minute cycle. So whenever we start CPR, we shouldn't be stopping until two minutes goes by, and then when two minutes is up, we have less than 10 seconds to do whatever we need to do for a patient and then begin chest compressions once again. So there's always a 10 second rule within the CPR cycle. Now as far as defibrillation goes, now remember what are the only two rhythms that we can defibrillate for cardiac arrest? They both have a VM v fib and pulsus v tech, you're right.

Perfect. So if we see the federal pulses v tag, what we want to do is Institute the one shock protocol. So basically what that means is when we see it, we want to defibrillate it or shock it and then the next thing we do right after we do that, is we actually go right back into chest compressions. No need to check for a pulse, no need to do anything else. We see it, we shock it, we start CPR again and finish out that two minutes cycle. The last thing to consider is rapid response teams.

Most hospitals have rapid response teams, and their job is to help us out when things kind of go a little bad. But the American Heart Association really wants them there early. They want them to be proactive versus reactive. So just keep that in mind with rapid response teams.